Provider Demographics
NPI:1871253823
Name:TAYLOR, RENADJA (HHP)
Entity Type:Individual
Prefix:
First Name:RENADJA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:RENADJA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HHP
Mailing Address - Street 1:1106 N HWY 360 STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2511
Mailing Address - Country:US
Mailing Address - Phone:682-323-7661
Mailing Address - Fax:817-549-4403
Practice Address - Street 1:1106 N HWY 360 STE 300
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2511
Practice Address - Country:US
Practice Address - Phone:682-323-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
TX230574005171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263332617OtherHEALTH & WELLNESS